Compression Only CPR?

Some countries have adopted compression-only CPR as the main method taught to the public, while other countries including Canada have not. All our courses teach you 30 compressions and 2 breaths in a cycle. So why the difference? Aren’t we all human?

CPR 30:2

In Canada the standard of CPR taught to everyone remains 30 compressions : 2 breaths and has been so for a long time. Is this a problem? Well, there was a worry about chest compressions being interrupted frequently to give breaths. When you’re doing compressions, you are pumping blood round the person’s body. Perhaps interrupting this to give breaths would reduce blood flow and maybe reduce the effectiveness of CPR. If that was true, then continuous compressions could be the better choice.

Before you read on, let’s make sure we’re talking about the same thing. Here ‘arrest’ means the person’s heart has stopped working.

To help us decide what to do in the best interests of the person needing CPR (and so what to teach you) smarter people then us do studies. Here are the main findings we need to look at:

  • In non-asphyxial arrest (eg: heart problems) continuous compressions are as effective as compressions that were interrupted for breaths
  • In contrast, in asphyxial arrest (eg: choking, drowning, anaphylaxis, asthma, etc.), ventilation improved outcomes

So for you, if you ever have to do CPR, doing both compressions and breaths is at least as good as compression only, and may be better depending on the cause of the problem.

Another recent  study was done in people found to have arrested, without looking at the cause (and you can read it here as well as finding the references for the statements above, if you like!).

The simplified version of their results is:

  • 9 out of 100 people who received continuous chest compression survived
  • 10 out of every 100 people who received chest compressions and breaths survived
  • So for that one person, it made a difference for sure.

What does that mean to you?

  • Stick to what you’ve been taught (30 compressions: 2 breaths) and if you haven’t had training recently, get some! If you were taught something different, we need to chat.
  • Don’t do what you see on TV (or YouTube) there are differences in teaching from one place to another.
  • The differences are pretty small – any CPR would still be better than no CPR. If you can’t do breaths for some reason, compression-only is OK. The Canadian Red Cross has a memo about that.
  • As we regularly teach in class, a lot of people who get CPR just don’t survive. If you ever have to do it and it doesn’t work, don’t beat yourself up about it. Be glad to know you gave them the best chance possible.
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First Aid Changes 2016

You’ll be aware from previous posts that things will be chasing over the next year. Here’s what we know from the Red Cross, with our own comments.

Every five years, the first aid and CPR guidelines are reviewed and updated. The new guidelines for first aid and resuscitation are based on recommendations from both the International Liaison Committee on Resuscitation (ILCOR) and the International Federation of Red Cross and Red Crescent Societies (IFRC), and are the result of scientific evidence reviewed by experts in their respective disciplines.Canadian Red Cross Training Partner

Canadian Red Cross and the Heart and Stroke Foundation are responsible for the evidence collection and guideline development of first aid and CPR for Canada. Red Cross First Aid Programs are currently being revised and will be released in 2016 and 2017. Highlights of the changes include:

  • When responding to an unconscious person who is breathing, the new Canadian guidelines recommend that the unconscious person be placed on their side in the recovery position. This is not a change, but the position used may be different… again.
  • Adult patients experiencing chest pain, believed to be cardiac in origin, should chew 1 adult or 2 low-dose aspirins (150-300 mg). Again, not actually a change.
  • In the case of severe allergic reaction, the new Canadian Guidelines recommend that First Aid providers should administer a second dose of epinephrine if there are no signs of improvement after the first dose. A slight change in emphasis, but basically no real difference here.
  • For superficial wounds and abrasions, only clean water should be used to wash out the wound, with a preference for running tap water. Previous guidelines recommended the use of soap and water, however studies have shown that when applied directly to an open wound, it can cause more harm than good. OK, here’s a change! There will also be a change in how long to clean wounds.
  • Anyone who has experienced a blow to the head, consistent with concussion, should be encouraged to discontinue activity and seek medical aid. OK, this is a change and an improvement. Previous teaching was to treat the same as a head injury, complete with spinal imobilisation (which may at times still be needed).

There are other changes, but right now we’re sticking to what’s relevant to you. The good news as you can see is that basically, nothing much has changed.

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Choosing Safety – Why it matters

All employers have a legal responsibility to educate their employees on all workplace safety standards and any (and all) hazards that their staff could encounter while on the job. ‘Training’ covers a huge range of topics, but give consideration to the following:

  • Promotion of Safety and Accident Prevention
  • Safe work habits & compliance with safety requirements/regulations
  • Employee engagement/involvement & Safety Culture
  • First Aid or other emergency response (method of response, timeliness, etc.)
  • Personal Protective Equipment (PPE)
  • WHMIS/chemical or hazardous materials at work
  • Environmental and workplace hazards

Any effective training programme should have many benefits for the employer and for the staff. Some of the benefits which could be anticipated are:

  • Electrical signReduce worker injury, illness and death
  • Reduce sick time or time off from work
  • Influence your exposure to legal liability
  • Reduce damage to worksite or property
  • Make everyone generally more healthy and happy!

Remember to document and record staff training – a training matrix can help with this.

Choosing Safety

So how do you decide what training is needed and by whom? You could of course buy every possible course for every staff member, but this would prove expensive! Try the following approach instead.

  1. Assess needs
  2. Determine staff skills & knowledge
  3. Find gaps
  4. Implement training
  5. Repeat

1. Assess Your (Staff, Company, Own) Needs

The first step is actually to decide what you need for your worksite. Local legislation will guide you, as will some of our articles and your own common sense. If you run a roofing company, our ladder and falls prevention courses may be just right – blood borne pathogens in healthcare would probably be less beneficial. Start by deciding exactly what courses you need, and write down a list. If you’re not even sure of what’s available, our online training site may be just the place to visit. You can browse through every course we offer and read a little about each one without having to commit to anything (or even register, looking is free!) 

One way to help think about this would be to break down your training into categories appropriate for your worksite. (We’ve tried to do this in our menu above.) Try the following:

Basics: Most worksites will need some sort of First Aid training, WHMIS is commonly required for all staff annually, Fire Safety may be appropriate. Consider training on PPE (personal protective equipment) and Hazard Assessment. 

People Issues: Once you have the basics noted down, move on to consider your staff themselves. Do you need driver training? Is Drug & Alcohol training necessary? What about Cultural Awareness in the workplace?

Environmental Issues: Safety training will not save the planet, but it will save your staff. Do they work in an area where they need bear awareness? What about Electrical Safety in your environment? Is there something in the warehouse/stores environment that puts them at risk for back injury? Think of the whole work environment; do not just dismiss this as ‘trees’ or ‘something for outside people’.

Equipment Issues: We have a whole lot of courses on these topics, because there could be many different issues: Forklifts, Chainsaws, Ladders, Slinging & Rigging, Hydraulics, etc. You know your job site better than we do – what issues do staff need training on?

Transport Issues: Last on our list – do staff transport goods, or drive on behalf of the company? It may not be enough to say they have a clean licence. Find out if anything else is needed – Transportation of Dangerous Goods? Winter Driving? 4-Wheel Drive…

OK, by now you should have started to develop a list of the safety training you need. If your worksite is big enough, consider getting someone else to do the same exercise and see if you agree. (Hint: if you want to develop that Safety Culture and get employee buy-in, why not get everyone involved in this decision?)

Start recording everything!

Read part 2 of this article

Just get some training

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Can repeated concussions cause brain damage?

Yes.

You want to know more…?

There is now enough evidence that doctors have created or I suppose – defined – a new condition called CTE: Chronic Traumatic Encephalopathy. ‘Chronic’ means it comes on over time, not just from a one-off head injury, ‘Traumatic’ – well we know that’s related to trauma or damage, ‘Encephalopathy’ – brain damage due to swelling. So CTE is a condition caused by repeated blows to the head, leading to eventual brain damage.

How did they decide this? The docs looked at pieces of brain, not knowing whose they were. (I’ll quickly point out this is after the people have died!) They found specific, obvious changes in the brains of some people. Once they had seen these changes they  were told which people the brains had belonged to. It was obvious that they were people who had chronic trauma. These changes could not be explained by any other disease or process. (They weren’t just normal changes from getting old.) They were only found in people who had head traumas.

So yes, they can be quite certain that repeated head injury (whether there are symptoms at the time or not) can lead to permanent brain damage.

How bad does the concussion need to be?

They don’t know yet. They did say CTE “has only been found in individuals who were exposed to brain trauma, typically multiple episodes” and that they don’t have to have had symptoms of concussion at the time. The CTE can start “months, years or even decades” after the last blow to the head.

What are the signs and symptoms of CTE?

  • memory loss, 
  • confusion, 
  • impaired judgment, 
  • impulse control problems, 
  • aggression, 
  • depression, 
  • eventually, progressive dementia

The head injuries seem to cause damage both to the outer layers of the brain as well as the deeper areas.

Treatment?

No, not yet. Although it’s a question often asked in class, they’ve only just figured out for sure that this happens. The best thing we can do is prevent head injuries from happening as far as possible; and know what to do if someone does get a head injury by taking training.

References:

The easier read (but not as easy as the notes above): http://www.neuroscientistnews.com/clinical-updates/cte-confirmed-unique-disease-can-be-definitively-diagnosed

The technical read: http://link.springer.com/article/10.1007%2Fs00401-015-1515-z

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